Abstract [en]

Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.

Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.

Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.

Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

Place, publisher, year, edition, pages

BMJ Publishing Group Ltd, 2017

Keywords

Lean healthcare, patient satisfaction, primary care

National Category

Health Care Service and Management, Health Policy and Services and Health Economy

Abstract [en]

Objectives

Despite the centrality of patient involvement in the policy and rhetoric of health care, the theoretical and empirical basis for patient involvement is lacking at the micro-level of practice. The purpose of this narrative review is to provide an overview and synthesize the current empirical research related to patient involvement at the micro-level of health care.

Design

Narrative review

Data sources: A database search was conducted (in Pubmed, CINAHL, Academic Search Premier, EconLit and PsycINFO) for articles published between 1990 and April 2015 in the field of patient involvement in health care. Out of 4238 references, 214 articles were eligible for this review.

Our narrative review includes a wide variety of empirical studies on patient involvement in decision-making, delivery and development, and provides an integrative perspective suggesting that patient involvement should be viewed not only as isolated activities, but also as a result of educating and preparing patients, staff and systems.

Abstract [en]

Purpose– The purpose of this paper is to explore what motivates patients to participate in service development and how participation may influence their well-being. Health-care providers are increasingly adopting practices of customer participation in such activities to improve their services.Design/methodology/approach– This paper builds on an analysis of data from a service development project in which lung cancer patients contributed by sharing their ideas and experiences through diaries. Out of the 86 lung cancer patients who were invited to participate, 20 agreed to participate and 14 fully completed the task. The study builds on participants’ contributions, in-depth interviews with six participants and the reasons patients gave for not participating.Findings– This paper identifies a number of motives: non-interest in participating, restitution after poor treatment, desire for contact with others, volunteerism, desire to make a contribution and the enjoyment of having a task to complete. A self-determination theory perspective was adopted to show how the need to satisfy basic human needs for autonomy, competence and relatedness determines if and how patients participate. Participation may have important benefits for patients, especially an improved sense of relatedness.Practical implications– Service providers must be prepared to meet different patient needs in service development, ranging from the need to express strong distress to expressing creativity. By understanding the dynamics of motivation and well-being, organizers may achieve better results in terms of improved services and in patient well-being.Originality/value– This study makes a significant contribution to the study of customer participation in service development, especially in relation to health care, by offering a self-determination-based typology for describing different styles of patient participation.

Abstract [en]

Background – Lean healthcare is claimed to contribute to improved patient value, but there is a limited research whether the application of Lean practices leads to improvement of patient perceived quality of care.

Methods –We used the data from the Swedish National Patient Survey to investigate if there are significant differences in patient-perceived quality of care between primary care units working with Lean and the control group, and if the patient-perceived quality improved over time. Moreover, to gain more in-depth understanding, we have performed two case studies in primary care units and investigate how the case organisations operationalized Lean principles with regards to definition and creation of value.

Results – The application of Lean healthcare practices doesn’t lead to improvement of patient perceived quality of care. In fact, the patients perceived a deterioration of quality of care in respect to informing them and meeting their needs. Providing timely and efficient care, which means reducing disturbances, waits and delays both for those who receive and those who give care, was an important principle characterizing Lean improvement work at case organisations. Little attention is paid to patient value and involving patients in improvement activities.

Conclusions –The implementation of Lean production in the guiding principles of service: customer value and value co-creation. Consequently, improvements tend to focus on internal efficiency and have a limited impact on patient experience. An important strategy is therefore to develop systematic approaches to specify patient value that integrate both the knowledge and clinical expertise of caregivers and the patients’ preferences and experiences in the application of Lean in healthcare.

Abstract [en]

This thesis adds to a stream of research suggesting that healthcare can be more patient centered and efficient by redefining the role of the patient from a passive receiver to a more active and collaborative participant. This may relate to healthcare provision (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) and innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Through research initiative containing four healthcare units and 68 patients, the present thesis combines healthcare research (e.g., Anderson and Funnell, 2005; Nelson et al., 2002) with service research (e.g., Grönroos, 2006; Vargo and Lusch, 2008, 2004) to explore three aspects of patient involvement and service innovation.

Firstly, the concept of patient involvement itself is investigated through an extensive literature review of empirical research on patient involvement. A model describing the antecedents, forms and consequences of patient involvement is proposed. What value is, and how patients can co-create value is discussed from the perspectives of healthcare research and service management thought.

Secondly, the thesis proposes a diary-based methodology for involving patients in service innovation. My colleagues and I developed the methodology in collaboration with the participating care providers and applied it in practice. We used the experiences we gained from the project and the contributions from the patients to examine the opportunities for user involvement in service innovation. The participants contributed with ideas and insights stemming from their experiences in their contact with healthcare and other resources. We suggest the following three ways of learning from the collected data: As ideas for improvements; through summary reports to illustrate other quantitative data; and as narratives to promote change.

Thirdly, the thesis explores patients’ motivations to participate in service innovation, a hitherto unexplored field. Through an analysis of patients’ contributions and interviews with participants we found that there are a number of factors that motivate patients to participate and that participation is perceived as a social- and meaningladen event. Patients derive psychological well-being and support from participation, but disease was sometimes a barrier to participation. This thesis elaborates on how the most motivated users can be involved in service innovation, applying thinking from the lead-user methodology to a healthcare setting.

Abstract [en]

This article explores how the most innovative users can contribute to healthcare service development through cocreation. Despite the widely acknowledged need to innovate and create more user-centered healthcare services, the role of the patient in service development is by tradition passive, and innovation is technology-centered. Drawing on the lead-user methodology, we examine the contributions and behaviors of the most innovative participants in a healthcare service development initiative through patient diaries. With openness, insight, and ingenuity, these patients combine capabilities for innovation with strong relational capabilities to suggest solutions for specific problems. While typical lead users are enthusiasts and lead trends, the examined patients have unmet needs and are often driven by affinity with the care provider and co-patients. We suggest a four-step approach to identifying and involving the most creative and engaged patients.

Keywords

Co-creation, service development, user innovation, healthcare

National Category

Engineering and Technology

Identifiers

urn:nbn:se:liu:diva-105927 (URN)

Conference

The 13th International Research Symposium on Service Excellence in Management, QUIS13 June 10-13, Karlstad, Sweden